Decision Support for Damage Control Resuscitation: Hemorrhage Helper

Injuries are the leading cause of death in people under the age of 45. We now know that many of these deaths — up to 30,000 per year in the US alone — can be prevented. The primary cause of death in these situations is severe bleeding. If the bleeding patient is recognized quickly as being at risk for death, measures to control the bleeding are taken immediately and the patient is quickly transported to medical care, they have an improved chance of survival. However, this chain of events has many weak points where the patient's hope of survival can be compromised.

We have proposed a novel solution to address these weak points in the chain of survival for severely bleeding patients. This solution is called a decision support system, which we have named the Hemorrhage Helper. This system takes data from pre-hospital providers and the trauma team and then gives the care team a 'heads up' that their patient is critically injured and may be severely bleeding. In cases where blood products are required to save the patient's life, this system gives recommendations based on the medical literature as to which blood products should be given while also keeping track of what has already been given to the patient. The system will also make recommendations regarding medications that may also help slow the bleeding while the team prepares the patient for definitive control of the bleeding in the operating room or other treatment locations in the hospital.

The benefits of this system are numerous. First, it will make sure the entire team is on the same page during the course of treatment for critically injured patients. It will provide the physicians up-to-date recommendations from the medical literature that are specific to the patient they are treating. It will also facilitate communication between the many team members that care for such patients — including Emergency Medicine physicians, Trauma Surgeons, Anesthesiologists, Trauma Nurses, Intensive Care Unit (ICU) Nurses, and the blood bank staff. Finally, this system makes sure that data from multiple different systems including the vital signs monitor, the electronic medical record, and the blood bank records are all factored into the treatment recommendation. The primary risk in any data integration and decision support system is the quality of the data and the trust the team puts into the recommendations that are made. Through the course of this proposal, we will take every measure possible to ensure the system performs optimally under a variety of conditions. We will also take steps to educate all the different team members on the system and its intended purpose so that there will be a high level of trust placed in the recommendations that it makes.

This system has already been in development for about 18 months. We now hope to further improve the quality of the system and prepare it for testing in a clinical environment over the next 2 years. If this proves successful, the system will then be ready for large-scale testing in multiple different hospitals and practice settings.

We anticipate that the Hemorrhage Helper will be a great asset to the combat medic and forward surgical teams who are responsible for managing a large number of critically injured patients. It will also be very useful to pre-hospital medics and physicians who care for civilian trauma patients in a wide variety of settings from the community hospital to the urban trauma center in a university hospital. Ultimately, we believe the Hemorrhage Helper will become an essential support tool for anyone who wants to improve the quality of their care for while managing severely injured patients.